Ensuring the physical and psychological safety of doctors in their workplaces is imperative in order to provide the best care possible to patients. To this end, Doctors of BC has taken significant action to improve workplace safety through the Memorandum of Agreement on Physical/Psychological Safety (now referred to as the Physician Health and Safety Agreement). Incorporated into the 2019 Physician Master Agreement, this Agreement makes it so that physicians have the opportunity to be included in widespread systemic change to better support physical and psychological health and safety in the workplace. It is also the first agreement of its kind in Canada and the first time Doctors of BC has worked with the Ministry of Health, the Health Employers Association of BC, health authorities, and health care related bargaining associations on issues specific to physician safety.
Doctors of BC is acutely aware of physical and psychological safety concerns in the physician workplace. In our 2021 Health Authority Engagement Survey - What We Heard Report, half of respondents indicated they believe effective actions are not being taken to promote a healthy and safe workplace. And in our 2021 Health Authority Engagement Survey, two key issues stood out:
1 in 2 physicians have been impacted by a physical/psychological safety incident
Only 1 in 2 physicians feel their hospital effectively takes action to prevent violence in the workplace
The ultimate goals of the Agreement are to:
The Agreement has established a number of new regional and provincial committees, structures, and working groups focused specifically on enhancing and improving physical and psychological health and safety in the workplace. It aims to accomplish this by supporting activities that enable consistent policies and procedures for physician specific occupational health and safety issues including: exposure management, contact tracing, enabling feedback loops, and more. The Agreement also provides funding for the following committees, structures, and Working Groups to begin activities that support physician health and safety.
Committees and Working Groups:
A number of regional and provincial projects and activities are underway that seek solutions to creating systemic change and that create opportunities for physicians to raise and provide input into health and safety issues and processes. Here is a list by Health Authority:
A number of projects have been making progress in 2022, including:
1. Physician Discipline and Respectful Workplace Processes: This project sought feedback from physicians on existing policies, processes and communications related to respectful workplace and disciplinary processes.
The process for obtaining medical staff feedback involved physician focus groups comprised of diverse physician representatives (family and specialist physicians) from across the Island. These focus groups took place over the course of 2020 and 2021.
As a result of this project, physicians drafted recommendations to the Island MOA Working Group. One recommendation was to form a specific Respectful Workplace Working Group, composed of health authority, Doctors of BC, and physician representatives to further explore and address the identified themes. This committee was developed through a regional nominations process for physician representation, and began its work in March 2022.
Status: Phase II of this project is underway and expected to continue through end of 2023.
2. Violence Reporting Processes: This project involves examining current processes and identifying barriers to physician violence reporting. It is expected that a set of recommendations will be developed around process improvement, and that this data will also serve as a channel for provincial reporting.
Status: Project is in the development phase.
3. Psychological Safety Webinars: The Island MOA Working Group funded a series of virtual psychological safety webinars, hosted to support educational opportunities, promote psychological safety in health care teams, and enhance quality improvement and leadership skills of physicians. Dr Mamta Gautam was the topic speaker for these sessions, which welcomed physicians from across the Island virtually. Click here for topic details.
Status: Project complete. New and expanded opportunities for medical staff are currently being explored for 2023.
Participants were extremely grateful for the opportunity to participate in these sessions.
“Thank you! Such an important topic and conversation, especially at this point in time in healthcare in Canada.”
“Dr. Gautam is a very thoughtful educator. I wish that the next time I'm on the receiving end of constructive feedback, it is delivered by someone who has learned from her style! This talk was exactly what I needed. Thank you for the rich discussions.”
4. Psychological Safety in the Workplace
This pilot project implemented a department-wide survey in the Island Health region to assess physician psychological safety in the workplace, and identify areas for improvement. The survey was developed through the Island MOA Working Group with physician contribution, and vetting and distribution by TWI Surveys Inc. Along with presentations to health authority leadership and the medical staff, a summary report was also provided to the Island MOA Working Group who will use the results to determine recommendations for next steps.
Status: Recommendations and next steps to be determined.
Process Mapping for Incident Reporting: An incident can be physical violence, a physical safety concern such as exposure or injury, or psychological safety, including discipline and respectful workplace issues. This project aimed to identify areas of improvement to create a more simplified pathway for physicians, medical leadership, and health authorities to report incidents, ultimately creating a more psychologically safe workplace.
Feedback was acquired through forty-three interviews among family physicians, specialists, MSA Presidents, Chiefs of Staff/Deputy Chiefs of Staff, and Northern Health Regional Medical Directors and Leadership.
The feedback led to the development of a number of themes and recommendations, including the formation of a working group to:
Physician Occupational Safety and Health Program (POSH): This program provides occupational health services for physicians, specifically on communicable disease management. It was created in response to COVID-19, to both provide these services in a crisis, and to help keep physicians safe and healthy.
The program is currently expanding to provide a concierge service for all medical professionals within VCH to report workplace violence. The main components of this project include:
Psychological Health & Safety Physician Education and Training: this project seeks to leverage content that was previously developed at BC Women’s and Children’s and expand training to physicians across PHSA. Training concepts would aim to operationalize clinical research and teaching practice to support a psychologically healthy and safe workplace. The following modules are currently under development:
Violent Incident Reporting: PHC is evaluating a mechanism for violent incident reporting, and looking to collaborate with both the Section of Emergency Medicine and the MSA Wellness working group in this process.
Evaluating psychological safety in the workplace: Physicians were compensated to attend debrief sessions that contributed to an environmental scan of the current state of the 13 pillars of psychological safety at PHC. Recommendations from the debrief sessions have been shared with senior leadership and the physicians that participated.
WorkSafeBC Physician Registration Guide: Doctors of BC and WorkSafeBC have updated the WSBC Physician Registration Guide to provide physicians with enhanced information on the processes and protocols for registering for WSBC coverage. The revised guide can be viewed here.
For further information specific to your region, please contact your Regional Advisor and Advocate.
Supporting BC physicians in their pursuit of workplace health and safety has become an increasingly important priority for Doctors of BC. Our work in this area includes our 2017 policy statement Promoting Psychological Safety for Physicians, our 2016 policy statement Preventing Violence in Healthcare, and local initiatives established via the Divisions of Family Practice and Medical Staff Associations.
For Doctors of BC resources on physician health and safety, please visit our Physician Health & Safety webpage.
Physical and psychological health and safety are vital in creating safe work environments that contribute to injury prevention and that cultivate innovative, engaged, and effective teams. Physician health and safety is comprised of two components:
In the absence of psychological safety, physicians are less likely to speak up, raise patient safety issues, suggest new ideas, or ask for help when they experience any of these events, for fear of reprisal or embarrassment. Research also shows that creating a work environment in which doctors feel safe contributes to their overall well-being, and is crucial for organizational efforts aimed at reducing medical errors, improving the coordination and quality of care, and increasing cost effectiveness.
Any physician who is experiencing issues of physical or psychological health and safety, or who has been involved or impacted by it in the past, is encouraged to contact your local Regional Advisor and Advocate.